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          <h1 class="post-title" itemprop="name headline">019.2019新锐读会 课程笔记《粘接牙科学的基本原理》02</h1>
        

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        <p>c.酸蚀方式+组合+步骤+层数+界面性质<br>第四代：<br>全酸蚀 酸蚀剂，底漆，粘接剂（3组） 3步 2层 疏水性 （是粘接金标准）<br>代表产品：OptiBond FL (Keer)<br>步骤繁琐，技术敏感性高。<br>第五代：<br>全酸蚀 酸蚀剂，底漆-粘接剂（2组）2步 1层 有一定亲水性<br>使用之前混匀。<br>代表产品：Single Bond(3M)， OptiBond S(Keer)， One-Step（Bisco）<br>五代改良：完成以后再涂一层疏水性的。<br>ENA Bond + ENA Seal(美塑）<br>All Bond3(Bisco，疏水五代) 分瓶装，A,B液，用前混合5秒，固化前有亲水性，固化后是疏水性。可能有敏感性发生，要求湿粘接。<br>第六代：<br>自酸蚀 酸蚀剂+底漆，粘接剂（2组），2步，2层，疏水性<br>主要针对术后敏感的问题。用弱的有机酸。<br>代表产品：Clearfil SE Bond(可乐丽)， ENA Bond SE（美塑）， OptiBond Versal（Kerr）<br>第七代：<br>自酸蚀 酸蚀剂+底漆+粘接剂（1组），1步，1层，有一定亲水性<br>主要代表产品：Easy-Bond（3M）<br>不建议永久充填/修复时用。<br>第八代：<br>全/自酸蚀 MDP等酸性功能单体+底漆+粘接剂（1组），1步，1层，疏水性<br>MDP: 10-甲基丙烯酰氧基癸基磷酸酯<br>代表产品：All-Bond Universal(Bisco)，ScotchBond Universal(3M)<br>通用性粘接剂：<br>①疏水性单层粘接剂。<br>②可用于光固化、双固化和自固化材料进行直接及间接修复体（最好不用自固化活化剂——接下来探讨）<br>③可使用所有酸蚀技术：全酸蚀、本质可自酸蚀或选择性酸蚀。<br>④由于内置处理剂可以促进与氧化锆，金属合金等间接修复时的粘固。<br>上市时间短，等待时间验证。<br>粘接系统总结：<br>三个成分：酸蚀剂(E)，底漆（P），粘接剂（B）<br>四代： E,  P, B 自酸<br>五代：E, P+B 自酸<br>六代：E+P, B 全酸<br>七代：E+P+B 全酸<br>八代：E+P+B 全酸自酸都行。<br>第二节 粘接系统的临床选择<br>1.直接修复（树脂充填）<br>a.粘接强度<br>目前市场上正规粘接系统都可以达到20MPa<br>机械力+化学键<br>20MPa = 平方厘米200公斤<br>b.粘接层是否有残留水？<br>第七代粘接剂溶剂中含水，易残留。<br>c.界面疏水性<br>第四、六代及改良五代能满足，第八代不好说。<br>总结：<br>优先选择四代、六代、改良五代，八代目前看也可以。<br>2.间接修复（粘接修复体）<br>条件与直接修复相似。<br>d.成膜厚度<br>e.与水门汀的兼容性<br>牙本质界面：直接与间接粘接前都要固化。<br>如果不固化，修复体就位加压时向外挤压，胶原纤维网会塌陷，导致粘接力下降。另外如果长时间不固化，牙本质小管液体会由于压力向外渗入到混合层，粘接力下降。实验证明未固化就放水门汀的粘接强度非常低。<br>提前固化的问题：成膜厚度。<br>成膜厚度小于10μm，不会影响修复体就位。<br>成膜厚度18-25μm，有风险。<br>成膜厚度&gt;50μm，不能接受，修复体无法顺利就位。<br>因此牙本质上涂粘接剂尽量薄，最好一层。现在大多粘接剂不含填料或低填料，较薄。<br>粘贴面的时候不用提前固化粘接剂，因为其界面是牙釉质。<br>e.与水门汀的兼容性-界面PH值<br>临床评价粘接剂的酸碱性以固化后PH值3为界，PH&gt;3，认为偏中性。PH&lt;3，认为偏酸性。<br>pH&gt;3的粘接剂与光固化，双固化和自固化的水门汀均可兼容。<br>pH&lt;3时，粘接剂与光固化水门汀兼容，与双固化、不含叔胺的双固化水门汀兼容，与含有叔胺的双固化水门汀不兼容。<br>间接修复的选择：单层疏水界面 成膜厚度&lt;10μm，pH&gt;3<br>第三节 粘接系统的发展趋势<br>1.步骤减少操作简单<br>3步-2步-1步<br>2.聚合前亲水聚合后疏水<br>3.吹干后无残留水分<br>4.含有最好的粘接活性单体<br>5.成膜厚度薄pH&gt;3，与自双固化树脂兼容。<br>6.对牙本质可以全酸蚀使用也可以自酸蚀使用。</p>
<p>**总结：<br>粘接剂分类，按酸蚀方式、组成成分、使用步骤、形成的界面的层数、以及界面性质进行分类。<br>临床选择粘接剂的考虑，直接充填主要考虑粘接强度（基本都够）、是否残留水（七代可能残留）、界面疏水性（疏水最好），因此主要选择四代，六代，或改良五代。八代也可以。间接修复，除了上述考虑外，还要考虑成膜厚度（厚度越小越好，大于50微米不能用），界面pH值（界面pH&lt;3的不能与含叔胺的水门汀合用）。<br>搜一下我用的产品：<br>可乐丽六代 SE Bond， pH=2.0，成膜厚度40-80微米。<br>3M 第八代 ScotchBond Universal，pH = 2.7，成膜厚度5-10微米。<br>用的粘固剂<br>3M RelyX U200/RelyX Ultimate Clicker(绿巨人)均为双固化，不含叔胺的。<br>因此临床上直接修复可用六代SEBond和八代3M SBU，间接修复最好用八代SBU。 **</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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